Friday, May 1, 2015

A rash of rashes/when do you need to worry

Please see the updated post September 2017
There are all kinds of rashes making the rounds recently so I figured that this is a good time to update this old post. Not only do we get calls about rashes, but these days we get emailed photos. I recall one day while I was with my daughter Lauren, I checked the emails on my phone. She looked over at a screen shot of a nasty looking rashy butt and said "OMG why would someone send  you a picture of that!?"

You can't imagine the emails we get. Rashes can be spotty, blotchy, hivey, oozy. They can be caused by allergies, virus, bacteria, fungus. They can be on only one body part or cover the entire body. They can be part of a chronic condition that comes and goes, or something acute.

Once in a while I can actually look at a photo of a rash and know exactly what I am dealing with, but more often things aren't completely clear cut. The most important thing really comes down to one very important and basic question: "Do we need to be worried about this rash?"

I divide rashes into two categories - Am I curious or concerned?

Rashes that I am curious about

If your child  is acting fine but has a random rash, ask yourself the following questions:

-Are there any new medications?
-Are there any new foods?
-Are there any new soaps, detergents, bubble baths?
-Have you used a new sunscreen or lotion of any sort?
-Has there been an exposure to a new animal?
-Has your child been in a hot tub?
-Is the weather very warm?
-Has your child been laying in the grass or sand?
-Have they been in a hot tub?
-Has there been any recent travel?
-Any recent hiking?
-Have you checked the mattress and area around the bed to see if there are any spiders or insects hanging around?

If your detective work has lead you to an answer, make the common sense adjustments.

My first attempt at clearing up many a rash is with several basic staples that are worth keeping on hand:

*Cetaphil cleanser (no water  needed, apply and wipe off)
*Over the counter Hydro cortisone cream/ointment for itchy areas
*Over the counter Neosporin or prescription Mupiricin for any open areas
*Over the counter anti-fungal cream/ointment for any possible yeast rashes.
*oatmeal bath (don't clog your drain with real oatmeal, there are special products used for this)
*You all know that I love adding a splash of apple cider vinegar to the tub for all sorts of rashes

If a rash is persistent and your best attempts at clearing it with a variety of OTC creams isn't helping, it is worth having someone take a look. If the docs are baffled, the next step may be the dermatologist.

If you had a mystery fever and then a rash comes out once the fever is gone, I am NOT as concerned about it. There are quite a few viral syndromes that wave goodbye with a rash. Feel free to call the advice nurse for help trouble shooting.    
Rashes that I am worried about

Any purple rash needs to be evaluated. These rashes don't lighten up when you press on them. If you have a child who has a purple rash and also has a fever and looks ill, they need to get to an emergency room immediately to rule out meningitis. A stiff neck, vomiting and headache would make me even more concerned. These kids look SICK.
Any rash that comes along with a fever at the same time is probably worth being seen. Strep throat can do this. We have still not ever seen an actual case of measles in the office, but that also would present with a rash and fever at the same time. The patient will look sick.

Other viral syndromes that may have the rash and fever at the same time are Slap Cheek and Hand Foot Mouth. We don't have anything other than suggestions for symptom relief for those. You simply will need to ride them out

If the rash is oozy and crusty it might be bacterial. Impetigo is fairly common.
If your child has had it in the past and you already have Mupiricin, you can try to treat a small area. If it isn't clearly taking care of things, an appointment is warranted. Sometimes oral antibiotics are indicated.

If a rash seems to have fluid filled centers, it could be chicken pox!

If the rash seems very painful or itchy certainly try Zyrtec or Benedryl, but if your child is uncomfortable let's get them seen to see if we can help. Some itchy rashes like poison oak may need oral steroids.

Hives are scary because most people associate them with a severe allergic reaction. It is true that if your child has hives along with any facial swelling or difficulty breathing, they need immediate attention. If they have a history of severe allergy to something, you should have an epi-pen or AuviQ on hand. Even after you use it, it is worth having your child checked out.

What most people don't realize is that most of the time hives are not always a big deal. They are a signal that the body is reacting to something, but often they come along with a virus. I have recently had a bunch of patients with mystery hives that have been cycling on and off for several weeks.

Any painful rash that is only on one side of the body and doesn't cross the midline could be shingles. It is rare for children to get this, but it can happen.

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